U.S. Savior: Foreign Doctors

This article by Greg Siskind recently appeared in USA Today on July 31.  

If some of the world's healers are allied with al-Qaeda, then are any of us really safe?  

Mohammed Asha and Bilal Abdulla, two of four people charged in last month's attempted car bombings in London and at the Glasgow airport, appeared in a preliminary court hearing last week. The fact that both are doctors suspected of the crimes is certainly distressing.  

Though the truth of the accusations against the doctors remains unresolved, another side of the story is not being told: Foreign medical graduates in the USA are the good guys saving lives everyday. They are not our enemies.  

Why haven't we heard any links of these foreign physicians to terrorism in the USA ? Most likely because of the extensive background checks that all skilled workers, including doctors, undergo before being admitted. British security clearances for skilled workers are not as extensive, and the process is under review.  

It might help to know some basic data:  

          - Physicians in the USA: 794,893.
- Foreign graduate doctors in the USA: 185,234 (from 127 countries).
- Percentage of doctors in U.S. training programs who are foreigners: 24%.

This is not a new phenomenon. Foreign physicians have made up about this percentage of our doctor population for years. A sizable portion work in medically underserved communities and small towns. This at a time when a shortage of doctors in the USA is expected to grow to as much as 200,000 by 2020.  

Few new medical schools  

Why is this shortage happening?  

First, the USA has opened almost no new medical schools in the past 25 years. So you have a physician population that has remained flat serving a U.S. population that is expected to grow by 25% between 2000 and 2025. Major demographic changes in the physician population also must be considered. Nearly one-third of doctors are older than 55, with more choosing early retirement. Fifty percent of all medical school graduates are now women. That is affecting both the total hours worked each year as well as the number of specialists. Family demands are causing many women to reduce their hours or to leave the profession when they have children. Some women doctors avoid fields with difficult call hours, such as anesthesiology and radiology.  

Then there are our own demographic changes. The number of Americans older than 65 will increase to 54 million by 2020. As we age, our need for medical care increases.  

Finally, as more treatment options are available and new technology is developed, Americans are more likely to seek out the services of a physician or specialist.

We must grow our domestically educated physician population. But it's going to take many years to get there. From deciding to build a medical school to seeing the first doctor start private practice is approximately 15 years. You've got to build the school, go through an accreditation process, educate the doctors (four years) and put them through graduate medical training (three to seven years). Why make our shortage worse by cutting off an important source of supply? About 5,000 foreign doctors enter the USA each year, and that number is already accounted for in the 200,000 shortage figure.

Selective process  

We're also losing more physicians as they finish training here. One reason is that physician shortages are growing in other countries as well. Australia and Britain have extreme shortages. Australia 's shortage is so severe that it has relaxed requirements.  

Many doctors are also engaged in cutting-edge research at some of the leading U.S. laboratories. One chief reason much of our best research is done by foreign graduates is because of the way they are chosen to come here. Every American medical student gets selected for residency and fellowship training programs. After that, we have 5,760 slots to fill. About a third of those go to American medical students who went abroad for medical school. The rest go to foreign nationals educated overseas.  

In order to get one of those remaining slots, a foreign student will need to have finished near the top of the class of a highly reputable medical school. These bright doctors come here because we have superior training and stay here to engage in top research at hospitals that have the budgets to offer high-quality treatment.

I tell you these facts because of the knee-jerk reaction I hear that we should take measures to prevent the entry of foreign-born physicians. This would be a disaster for American health care, and it would not make us safer. We need to increase physician immigration and increase the supply of U.S. medical school graduates. Otherwise, we'll face a future of rationed health care.  

The solution is not to bar foreign doctors. We already vigorously screen those coming here and can increase screening as needed. American patients benefit every day from this meritocracy, and the number of lives these doctors saves will far exceed any trade-off we would get spooked by an irrational fear.

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